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January 27, 2003

East Meets West: Integrating Complementary Medicine into Your Care
Bradly Jacobs, MD, MPH

Key Points
- Over 40% of the United States population has used complementary medicine.
- Examples of these therapies include herbal medicines and dietary supplements, massage, chiropractics, acupuncture, self-help groups, energy healing, and homeopathy.
- Americans spend over $27 billion in out of pocket expenditures on complementary medicine therapies
- Complementary medicine accounts for 600 million office visits a year compared to 350 million total visits to all Primary Care Providers in the United States.
- Only one-third to one-half of people inform their provider about their complementary medicine use.
- Up to two-thirds of people using complementary medicine are women

What is Complementary Medicine?
There are a wide array of different health care systems that exist in the world and that are utilized by a variety of practioners in many settings. Since these systems are not commonly taught to medical doctors in medical schools, they have be called Alternative or Complementary Medicine. In the United States and Europe, the most widely used systems include:
Traditional oriental medicine which emphasizes the proper balance of qi (pronounced chi), or vital energy, in health and disease. Traditional oriental medicine consists of a group of techniques and methods, including acupuncture, herbal medicine, massage, and qi gong (a form of energy therapy described more fully below). Diagnosis is based on identifying similar patterns in multiple diagnostic methods which include the history, and the examination of the pulse, tongue, and abdomen. Treatment is individualized. Consequently, 10 people presenting for tension headache may receive 10 different treatments.

- Homeopathic medicine is based on the principle that like cures like, In other words, a substance that produces symptoms of an illness in large doses, will cure it in small doses. Homeopathic physicians use small doses of specially prepared plant extracts and minerals to stimulate the body's defense mechanisms and healing processes in order to treat illness. Diagnosis is based on a comprehensive history intake that searches for patterns and symptoms. Treatment is based on the constellation of presenting symptoms. Consequently, 10 people presenting for tension headache may receive 10 different treatments.

- Ayurveda medicine meaning science of life is India's traditional system of medicine that places equal emphasis on body, mind, and spirit, and strives to restore the innate harmony of the individual. Ayurvedic treatments include diet, exercise, meditation, herbs, massage, and controlled breathing.

- Each health care system utilizes a combination of therapies in order to promote health, prevent and cure illness, as well as address the physical, mental, emotional, and spiritual needs of the patient. Examples of these therapies include: massage, body work, herbs, meditation and manipulation (i.e. chiropractic). Some of these treatments can also be used outside of the full system from which they come. For example, an acupuncturist (L.Ac) is trained in all aspects of traditional Chinese medicine including acupuncture, herbs and massage. However, a Licensed Massage Therapist (L.M.T.) is only trained in massage therapy.

- What is Integrative Medicine?
Integrative Medicine is a new health care model that seeks to combine the best of both conventional and complementary medicine to address the biological, psychological, social and spiritual aspects of health and illness. Integrative Medicine physicians are medical doctors who are trained in both conventional and alternative therapies who value the principles of integrative medicine and will professionally guide patients through the various health care systems and treatment options.

Integrative Medicine is based on four primary principles:
- Emphasizing respect for the human capacity for healing,
- Placing importance on the relationship between the practitioner and the patient,
- Creating a collaborative team-based approach to patient care among practitioners, and
- Encouraging patients to participate in their care and to learn about selfcare methods in order to promote their own wellness.

Books and Published Articles
- General:
Eisenberg DM et al: Trends in alternative medicine use in the United States, 1990--1997. JAMA 1998;280;1569. [NLM Cit ID: 99036143]
Astin JA: Why patients use alternative medicine: results of a national study. JAMA 1998; 279: 1548. [NLM Cit ID: 98266936]
Levin J, Jonas W: Essentials of Complementary and Alternative Medicine. Lippincott Williams & Wilkins, 1999.

- Herbal Medicines:
Murray M, Pizzorno J.: Encyclopedia of Natural Medicine, Revised 2nd Ed.
Blumenthal M: et al Herbal Medicine. Expanded Commission E Monographs. American Botanical Council. Integrative Medicine Communications, 2000.
Fetrow C, Avila J: Professional's Handbook of Complementary and Alternative Medicine. {Springhouse Publications, 1999.
Shulz V, Hansel R, Tyler VE: Rational Phytotherapy: A Physician's Guide to Herbal Medicine.Springer, 1998.

- Acupuncture
Kaptchuk T: The Web That Has No Weaver: Understanding Chinese Medicine. NTC/Contemporary Publishing Book, 2000.
Stux G, Hammerschlag R (editors): Clinical Acupuncture: Scientific Basis, 1st ed. Springer 2000.

- Homeopathy:
Chapman E: Homeopathy. In: Essentials of Complementary and Alternative Medicine. Jonas W, Levin J (editors). Lippincott Williams & Wilkins, 1999.

Bradly Jacobs, MD, MPH is board-certified in Internal Medicine and has studied other therapies including acupuncture, herbs, yoga and martial arts. Dr. Jacobs has a particular interest in chronic pain management.

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